Toxicology Critical Care

Use of recreational drugs and subsequent addiction, intentional and accidental drug overdose, exposure to toxic chemicals, such as pesticides and insecticides, and snakebites, especially by venomous snakes, require prompt medical intervention to prevent morbidity and mortality. The team at the toxicology critical care unit manages these patients through early assessment, stabilization, laboratory evaluation, decontamination, antidote administration, enhanced elimination of toxins, and disposition.

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Diseases and conditions

  • Pesticide and Insecticide Poisonings: Insecticide and pesticide poisonings may occur when they are swallowed or absorbed through the skin. The most common symptoms include nausea, headache, increased secretions (saliva, sweating, and tears), and dizziness.
  • Drug Overdose: Drug overdose may occur when the drugs are swallowed, injected, or applied in quantities much higher than recommended. It may be either intentional or accidental.
  • Recreational Agent Overdose: Recreational agents are the chemicals ingested, inhaled, or injected for enjoyment rather than treatment. Some recreational drugs are amphetamine, amyl nitrates, cannabis, cocaine, heroin, ketamine, and MDMA. Taking excessive quantities of these drugs results in their overdose.
  • Snake and Insect Bites: Patients with snake bites have swelling and pain around the bite. However, if the snake is poisonous, symptoms also include headache, fever, numbness, and convulsions. People may also experience an allergic reaction to insect bites.

Procedures and treatment

  • Supportive care: Supportive care is essential to the poisoned patients to maintain the functioning of vital organs until these functions are permanently restored by specific treatment. The supportive therapy includes initial resuscitation, airway management, and circulatory monitoring.
  • Antidote Administration: Antidotes are medications that counter the toxic effects of poison. These agents either modify the toxin kinetics or interfere with their effect at the receptor sites.
  • Toxin-Effect Targeted Therapy: Antidotes work through several mechanisms, and specific toxins are targeted with specific therapies based on the mechanism of action. The mechanisms include binding to the toxin (activated charcoal), enhancement of enzyme function (oximes administered for organophosphorus poisoning), competitive inhibition of enzymes (ethanol administered for methanol poisoning), and competitive receptor blockade (flumazenil and naloxone).
  • Extracorporeal Filtration Therapies: These therapies remove toxins from the blood and play a major role in managing overdose and poisoning. The therapies used are hemodialysis, high-molecular-mass cutoff, continuous renal replacement therapy, hemoperfusion, and plasma exchange.


Toxicology Critical Care refers to the specialized medical care provided for individuals who have been exposed to toxic substances, such as pesticides and insecticides, or have experienced drug overdoses or recreational agent overdoses.

Common types of poisonings treated in Toxicology Critical Care include pesticide and insecticide poisonings, drug overdoses, and recreational agent overdoses.

Pesticide and insecticide poisoning can happen through inhalation, ingestion, or contact with the skin. Exposure may occur during agricultural activities, household use of pesticides, or accidental intake by children.

Symptoms of pesticide and insecticide poisoning can vary depending on the specific substance involved but may include nausea/vomiting, difficulty breathing, neurological effects (such as seizures), skin irritation/allergic reactions, and gastrointestinal disturbances.

If you suspect someone has been poisoned by a pesticide or insecticide:

  • Call emergency services immediately.
  • Try to remove the person from further exposure.
  • Do not induce vomiting unless instructed to do so by medical professionals.
  • Provide any information about the substance involved if possible.

Drug overdose cases requiring toxicology critical care often result from accidental misuse/mismanagement of medications or intentional abuse/overdose involving prescription drugs (e.g., opioids), illicit drugs (e.g., cocaine), or other substances like alcohol combined with certain medications.

Signs that someone may be experiencing a drug overdose include:

  • Altered mental status (confusion, delirium)
  • Unresponsiveness or difficulty waking up
  • Shallow or labored breathing
  • Seizures
  • Excessive drowsiness

If you suspect someone is experiencing a drug overdose:

  • Call emergency services immediately.
  • Stay with the person and monitor their vital signs.
  • Do not leave them unattended until medical help arrives.

Recreational agents refer to substances used for non-medical purposes, such as illicit drugs, party drugs (e.g., MDMA), hallucinogens (e.g., LSD), or other psychoactive substances. Overdoses of these agents can occur due to excessive consumption, adulteration with unknown substances, or unpredictable reactions.

Recreational agent overdoses can lead to severe health consequences ranging from cardiovascular issues and respiratory distress to neurological complications like seizures or organ failure.

Recreational drugs increase dopamine levels in the brain. Dopamine is a chemical associated with pleasure. When recreational drugs are used for a long time, the brain reduces the natural production of dopamine as a response to the continuous triggering of dopamine synthesis. This results in the desire for a continuous supply of recreational drugs to feel pleasure.

Venoms may be neurotoxic, proteolytic, cytotoxic, or hemotoxic. Neurotoxic venom affects the nervous system and causes paralysis of the muscles. It damages the brain and makes the patient unconscious. Proteolytic venom contains proteolytic enzymes. These enzymes are present in the venom of all snakes. It degrades the tissues, especially at the site of the bite. Hemotoxic venom affects red blood cells. It results in severe internal bleeding, cardiovascular failure, and limb amputation. Cytotoxic venom kills the cells and causes disability in the patient.